What’s the Difference Between Normal Grief and Depression?

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Unbearable sadness, sleepless nights, trouble focusing on work. Grief and depression can feeland from the outside, appearawfully similar. This is especially true since we know that there is no “normal” way to grieve: Experts stress that grief can come and go in waves for months or even years after a loss, and feature a whole host of messy, unpredictable emotions that can’t be neatly defined. But at what point does sadness over the loss of a loved one veer into the territory of something more serious?

The question of how to tell the difference between grief and depression “is one we have been debating for literally a hundred years,” says Kenneth J. Doka, PhD, a professor of gerontology at the Graduate School of The College of New Rochelle and senior consultant to the Hospice Foundation of America. He explains that most grief scholars pinpoint the current study of grief as beginning with Sigmund Freud’s 1917 article Mourning and Melancholia. “And that’s exactly what Freud was trying to do: differentiate the sadness of grief from depression.”

Grief vs. depression

Experts are still grappling with this question, but they say that there are a few red flags to look out for. One important distinction the American Psychiatric Association (APA) uses to differentiate between grief and depression is whether or not feelings of sadness are interspersed with more positive emotions.

“If you have moments or even days of sadness, that’s normal and natural,” says Doka. But in between those bouts of grief, you’re able to feel other emotions, too; maybe it’s pleasure from a happy memory of you and your loved one, or even amusement from a mindlessly funny TV show. As time goes on, these non-grief feelings will hopefully become more and more frequent and pronounced.

On the other hand, with depression, mood is “almost constantly negative,” according to the APA.

Another big red flag is grief that seems to sap a person of their sense of self-worth. Aside from their sadness, people who are grieving can usually still feel like themselves. But with depression, they may appear to have intense feelings of self-loathing and worthlessness.

And while grief can also make it difficult to concentrate at work, depression is more likely to impact your productivity in the long term.

“If you consistently can’t focus—not just a couple of days, not just a couple of weeks—but if you really just can’t focus on work or the task at hand, that could be a sign of something more,” says Elizabeth Lombardo, PhD, a psychologist based in Chicago.

Other possible signs of depression include becoming increasingly socially withdrawn and unable to interact with other people, or feeling sudden physical manifestations of grief, such as horrible headaches or neck aches.

“That could be a sign of something psychological going on,” explains Lombardo. “We know that when we have so much distress, our body can manifest in chronic pain.”

When in doubt, consider getting help

For many years, the Diagnostic and Statistical Manual of Mental Disorders (DSM), the system most frequently used in the United States to categorize mental health conditions, excluded people who had suffered a loss from being diagnosed with a major depressive disorder until after two months. But in 2013, the APA made the decision to remove this “bereavement exclusion” from DSM-5.

The move was controversial, with some arguing that it could lead to an overdiagnosis of antidepressants for those who were grieving, or “medicalize” the normal human experience of grief. The result, though, is that anyone who is feeling like they could have symptoms of depression should feel empowered to seek treatment at any pointno matter how recently a loved one has died.

Regardless of whether or not you think you have clinical depression, it’s never a bad idea to book an appointment with a mental health professional to check in.

Lombardo says that grieving patients will often tell her that they didn’t think there was any reason to see a therapist for their grief because the issue was painfully obvious: their loved one was gone. But she stresses that you don’t have to wait for full-on clinical depression in order to find someone to help you feel better.

“There are two ways to solve a problem: problem focus, which [in this case] would be bringing the person back to life, and emotion focus, working on your own emotional reaction to it,” she notes. “When we’re dealing with a death, you can’t change the situation, but you can deal with your reaction to it.”

Others think that because they have a big support system of friends and family, they don’t need professional help as well. But a mental health professional can help you work through complicated emotions about a loss that are difficult to talk about with other people in your life, such as feelings of regret (“I should have done this,” or “I shouldn’t have done that”) or even guilt or anger towards the person who died.

“Sometimes it’s hard to say, for example, ‘I’m really mad at mom for smoking for 30 years,’’ Lombardo says. “That may be hard to communicate and work through with your siblings, for example, because they may be feeling the same way. Finding someone to help you get through the process can be wonderful.”

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